Burnout

Burnout was described by Christina Maslach as three things together: exhaustion, cynicism or detachment from the work, and a sense that you are no longer effective (Maslach & Leiter, 2016). The World Health Organization’s ICD-11 calls it an occupational phenomenon, not a medical condition (WHO, 2019).

That distinction matters in practice. Burnout is not a diagnosis, but the person who is burned out may well have one. When I evaluate burnout, I am looking for depression, anxiety, ADHD, a sleep disorder, substance use, or a medical problem that is making the work harder than it should be. Sometimes burnout is a job problem and nothing more. Often it is both, and treating only one half does not work.

Burnout is widespread in medicine. In a 2021 survey of US physicians, 62.8% reported at least one symptom of burnout, up from 38.2% a year earlier (Shanafelt et al., 2022). Physicians, nurses, residents, attorneys, tech workers, and executives all come to me with the same story: competent, conscientious, and quietly running on empty.

What I see

• Dreading work you used to care about

• Getting through the day on adrenaline and caffeine, then crashing

• Short temper at home, and nothing left for relationships or hobbies

• Emotional numbness toward patients, clients, or colleagues

• Drinking more than you used to, or relying on sleep aids

• A growing feeling that the only way out is to quit medicine, law, or your field entirely

Care for physicians and professionals

I built my practice with physicians and high-pressure professionals in mind. I am not part of your hospital or employer’s system. Many physicians delay care because they worry about what appears in records, on credentialing forms, or in a licensing application. We can talk through what those forms actually ask and when it makes sense to check with a physician-health attorney or your state board. I will not pretend there is no risk in every situation, and I will not let the fear stop you from getting help.

Treatment is practical. We look at sleep and workload first. If there is an underlying condition, we treat it. We also work on what you can change at work, such as schedule, scope, boundaries, and support, and what you cannot. If time off or reduced hours would help, I can document that when it is clinically appropriate. Sometimes the right outcome is staying and adjusting. Sometimes it is leaving, and I would rather you make that choice with a clear head than in the middle of a crash.

Grief

Grief is not an illness. It is the natural response to loss, and there is no schedule for it. Waves of sadness, yearning, anger, guilt, and numbness are expected, and they usually soften with time even when they never fully disappear.

For some people, the grief stays acute and disabling. Prolonged grief disorder was added to the DSM-5-TR in 2022. It is diagnosed when, at least a year after a death (six months for children and adolescents), a person still has intense yearning or preoccupation with the person who died, along with symptoms such as emotional pain, numbness, difficulty accepting the loss, a sense that part of you has died, feeling that life is meaningless, or trouble reconnecting with others, to a degree that interferes with life (APA, 2022).

I see grief after the death of a parent, partner, child, or friend, after a pregnancy loss or stillbirth, and after losing a patient. I do not rush it, and I do not try to medicate it away. I look for depression, sleep problems, and anxiety that may need their own treatment. A focused grief therapy, which has been tested in a randomized trial, helped about half of participants with complicated grief, compared with about a quarter of those who received standard interpersonal therapy (Shear et al., 2005). I can help you find a clinician trained in it.